CARDIOVASCULAR MEDICINE

Post-traumatic stress disorder in patients with cardiac disease: predicting vulnerability from emotional responses during admission for acute coronary syndromes

D L Whitehead, L Perkins-Porras, P C Strike, A Steptoe

Department of Epidemiology and Public Health, University College London, London, UK

Correspondence to:
Dr Daisy L Whitehead
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; daisy.whitehead{at}ucl.ac.uk

Objectives: To assess frequency and predictors of post-traumatic stress disorder (PTSD), measured by the Post Traumatic Stress–self report version, at three months after admission for acute coronary syndromes (ACS).

Design: Two-phase prospective study.

Setting: Four coronary care units.

Patients: 135 patients admitted to hospital with ACS confirmed by ECG and cardiac enzyme changes.

Results: 20 patients (14.8%) showed a symptom pattern characteristic of PTSD at three months assessed by a conservative scoring criterion. Severity of chest pain and psychological factors during admission were predictive of PTSD severity. Acute stress symptoms, depression, negative affect, hostility, and pain scores were independent predictors of three-month PTSD symptoms (R² = 0.495, p < 0.001). In contrast, demographic factors (age, sex, education level and income) were unrelated to post-traumatic symptoms, as were markers of clinical disease severity.

Conclusions: Patient vulnerability to PTSD three months after ACS is predictable on the basis of psychological state and chest pain at the time of admission. This may be valuable to the clinician, as PTSD after myocardial infarction is associated with poorer quality of life, reduced adherence to drug treatment and increased likelihood of cardiovascular morbidity.

Abbreviations: ACS, acute coronary syndromes; BDI, Beck Depression Inventory; DS16, Type D scale-16; DSM IV, Diagnostic and statistical manual of mental disorders, 4th ed; GRACE, Global Registry of Acute Coronary Events; MI, myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; PSS-SR, PTSD Symptom Scale–self report version; PTSD, post-traumatic stress disorder; STEMI, ST elevation myocardial infarction

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